Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Summarize the role of ultrasound and mammogram in evaluation of a palpable mass 2. Recall what BI-RADS level should prompt a biopsy
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Jan 25 2023, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
While multiple disciplines are required to diagnose and manage both benign breast disorders and breast cancer, the most important interaction with a patient remains the initial office visit
Obtain careful history of all breast related symptoms including duration, changes in symptoms over time, presence and color of nipple discharge
Identify risk factors for breast cancer, including
Advanced age (over 65)
Positive family history
Age >30 at first birth
Menopausal hormone therapy
Alcohol use (not clear what the threshold is)
Visually inspect and manually palpate the breasts, axillae and supraclavicular nodal regions
Clinical documentation of any mass should include size, consistency, distance from areola and clock position in the breast
Diagnostic imaging includes ultrasonography, mammogram or digital tomosynthesis
Manage breast lesion based on age, clinical suspicion, Breast Imaging Reporting and Data System (BI-RADS) and other imaging findings
Ultrasound can differentiate solid from cystic lesions
Histology can be obtained from fine needle aspiration (FNA), core needle biopsy or excisional biopsy, procedures that are usually performed by radiologists or surgeons
Women ≥30 years and older with palpable mass
Mammogram followed by ultrasound, if necessary
Women under 30 years with a palpable mass: Ultrasound is the primary imaging modality
If ultrasound imaging is suspicious for cancer, follow up with tissue biopsy
If ultrasound does not suggest malignancy but clinical suspicion remains, perform a diagnostic mammogram
If ultrasound imaging suggests a benign cyst or a benign appearing solid mass options are to follow-up with physical exam +/- ultrasound/diagnostic mammogram every 6-12 months for 1-2 years to assess stability
Women presenting due to a mass that cannot be palpated by patient or clinician should not be dismissed and must be followed up with imaging
Benign breast lesions can be categorized as nonproliferative (breast cysts), proliferative without atypia (fibroadenoma, intraductal papilloma, fibrocystic change) which may carry a small risk (1.5 to 2 times above general population) for breast cancer and atypical hyperplasia (ductal or lobular). The latter category carries a substantially increased risk of subsequent invasive cancer in either breast (see ‘Related ObG Topics’, below). Nipple discharge is common, and usually benign. Unilateral, uniductal and spontaneous discharge carries a higher risk of malignancy and should be further evaluated with ultrasound.
Women ≥30 years with palpable breast masses shown to be solid on imaging should be biopsied if BI-RADS 4-5, or if BI-RADS 1-3 with high clinical suspicion
Observation an option if BI-RADS 1-3 and low clinical suspicion (see ‘Related ObG Topics’ below)
Women with simple cysts can undergo routine follow-up
Consideration for biopsy should be given to complicated cysts with BI-RADS 1-3
Complex cysts with BI-RADS 4-5 on imaging require biopsy
When common skin problems are identified in the breast such as psoriasis, eczema, contact dermatitis, Candida infections, standard treatment should be used
Skin edema, warmth and erythema as well as ulceration, nipple retraction/crusting/scaling should raise concerns for malignancy and require tissue diagnosis
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
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